Indianapolis, IN asked in Medical Malpractice, Consumer Law, Civil Litigation and Health Care Law for Indiana

Q: I had surgery last year (pre-approved by ins). After, the Anesth. Dr billed me as he was temporarily out of network.

I got insurance pre-approval for the procedure and spoke with the scheduler to ensure that everything was covered so there were no surprises (my exact words). Afterward - the Anesthesiologist balance billed me for the procedure as they said they were out of network. Insurance paid them based upon them being in network. A letter about a month later was sent to the scheduler by the Anesth. office noting that they were out of the network. Later last year they were back in-network so I managed to get caught during this few month window and they are unwilling to apply in-network discounts for me. Is this something that I would likely win in small claims court? Do I have other legal recourse? Also, do I risk having to pay attorney fees on their end if I lose in court?

1 Lawyer Answer
Peter N. Munsing
Peter N. Munsing
  • Medical Malpractice Lawyer
  • Wyomissing, PA

A: I would suggest to the facility that arranged for the pre cert that if they have an out of network person for anesthesiology then it is up to them to tell you, and tell the anesthesiologist as he didn't let you know he was out of network you are not paying.

At the same time, I'm not seeing that you ran it through the out of network on your policy. Suggest you file a complaint with the medical board and also the insurance commissioner for your state. It's a common problem and there may be legislation pending similar to New York's

Tell your legislators you want a stop to this. Tell your Congressman and Senators as well!

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